J Korean Ophthalmol Soc.  2012 Apr;53(4):536-543.

Cystoid Macular Edema Detected by Scanning Laser Ophthalmoscopy in Retro-Mode

• Lee WJ
• Cho HY
• Lee BR

Abstract

PURPOSE
To investigate the visualization of cystoid macular edema (CME) using noninvasive retromode imaging by a new scanning laser ophthalmoscope (SLO) and compare to previous imaging modalities.
METHODS
The authors of the present study retrospectively reviewed the medical records of 21 eyes of 20 patients with CME due to various etiologies. All eyes were examined with fundus camera, fluorescein angiography (TRC-50EX, Topcon, Tokyo, Japan), SLO (F-10, Nidek, Gamagori, Japan), and spectral-domain optical coherence tomography (OCT) (3D OCT-1000, Topcon, Tokyo, Japan). In the present study the SLO was used in the retro-mode with an infrared laser.
RESULTS
Previous fundus photography could not detect CME adequately although SLO retro-mode could show numerous oval or polygonal cystoid spaces more readily. Furthermore, each individual small cystoid space could be detected and the area of each cystoid space could be measured. The area of the largest cystoid space showed a correlation with its height, as measured with OCT (R = 0.606, p = 0.004). The area of the whole foveal cystoid space showed a correlation with central macular thickness, as measured with OCT (R = 0.493, p = 0.023).
CONCLUSIONS
A new commercially available SLO (F-10) in the retro-mode can allow us to detect each cystoid space non-invasively and to measure the extent of CME.

Keyword

Cystoid macular edema; Optical coherence tomography; Retro-mode; Scanning laser ophthalmoscope

MeSH Terms

Eye
Fluorescein Angiography
Humans
Macular Edema
Medical Records
Ophthalmoscopes
Ophthalmoscopy
Photography
Retrospective Studies
Tokyo
Tomography, Optical Coherence

Figure

• 

  Figure 1 (A) Confocal mode: Images consist primarily of direct reflex from the vitreomacular interface. (B) Indirect mode with a ring aperture: Direct reflex from the vitreomacular interface is blocked with a central stop. More multiply scattered light from intraretinal structure is collected by the detector. (C) Retro-mode: The opening of the ring aperture is restricted and is deviated laterally from the confocal light path. Multiply scattered light from only one direction is collected by the detector.

• 

  Figure 2 (A) The largest cystoid space is selected on retro-mode image and the area of the cystoid space can be measured using the loaded software in F-10. (B) The height of the selected cystoid space can measured using the loaded software in 3D-OCT.

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  Figure 3 A case of 29-year-old woman with idiopathic cystoid macular edema. (A) No cystoid spaces are detected on fundus photography. (B) Late-phase fluorescein angiography shows many cystoids spaces. (C) Scanning laser ophthalmoscope (SLO) retro-mode shows numerous polygonal cystoid spaces.

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  Figure 4 A case of 64-year-old woman with central retinal vein occulsion. (A) No cystoid spaces are detected on fundus photography. (B) Late phase fluorescein angiography cannot show cystoid spaces obviously due to leakage from vessels and choroidal fluorescence. (C) Scanning laser ophthalmoscope (SLO) retro-mode shows numerous fine small cysts in the macular area.

• 

  Figure 5 A case of 46-year-old man with vitreous hemorrhage due to proliferative diabetic retinopathy. (A) No cystoid spaces are detected on fundus photography. (B) Late-phase fluorescein angiography cannot show cystoids spaces obviously due to media opacity caused by vitreous hemorrhage. (C) Scanning laser ophthalmoscope (SLO) retro-mode shows numerous cysts despite media opacity.

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  Figure 6 The area of the largest cystoid space measured with a scanning laser ophthalmoscope (SLO) retro-mode shows a correlation with its height, as measured with optical coherence tomography (OCT) (R = 0.606; p = 0.004).

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  Figure 7 The area of the whole foveal cystoid space measured with a scanning laser ophthalmoscope (SLO) retro-mode shows a correlation with the central macular thickness, as measured with optical coherence tomography (OCT) (R = 0.493; p = 0.023).

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